Excellent advice Dr Mc Bride. The first thing to do, for sure, if someone complains of cognitive changes is to remove or ameliorate the multiple metabolic, neurologic and psychological factors that affect cognitive function, including the very real cognitive changes that often come with menopause and loss of estrogen. And yes, this requires careful listening and very nuanced management, over time. Even if correction to these factors does not yield a positive picture, then yes, one has to get into objective assessments, as you mentioned. I do want to throw in a reminder that, should there be reason to think there are cognitive changes underlying all these factors that have been addressed, then an experienced, qualified Speech Therapist or Speech Pathologist, (same person) often plays a key role in a) cognitive assessment b) helping an individual develop and use strategies to cope better or cope well, even with cognitive changes, in daily and prospective functioning. Since I have been involved with such cases, I have also had to meet with people just concerned about normal aging changes they are experiencing, to assess and address how they can help themselves and provide the necessary reassurance and education. Happy to talk with you further. I am based in Massachusetts.
Wonderful analysis of possible causes to fatigue and brain fog. Often these symptoms are multifactorial. As a dietitian, I like your reminder about not skipping meals (and I suggest combining protein and complex carbs at each meal). One factor you didn't mention is the very high incidence of long Covid syndrome, that can contribute to brain fog and fatigue. The patient may wish to think about whether her symptoms worsened within several months of a confirmed COVID-19 infection.
Yes indeed.. cognitive impairment can be a result of myriad medical conditions.. too numerous to count. Long COVID is real and can have meaningful negative effects on cognition, but it’s not at all clear to me what the actual incidence is… given the muddy definition and other factors such as poor access to healthcare in this country which can make long COVID a convenient bucket to put medical problems that are more complicated that meets the eye… and that sometimes are indeed directly a result of COVID but that also can stem from other medical issues that are more difficult to discern without proper medical care.
Thank you for this wonderful, insightful post! Besides listening to yourself, the most important thing is finding a trusted medical guide. As your post shows, that’s getting harder and harder to do. Your patients are truly lucky to have you.
I think over-medicalization is a serious problem in this country - whether it's around menopause or anxiety or obesity or high cholesterol or cancer. To me, the question isn't "Are we over-medicalizing elements of the normal human experience in the U.S.?" We are!
The more salient question is, "How can we better meet the patient's needs through the combination of pharmacology, behavioral modifications, counseling, and reassurance when/if appropriate?" Instead of treating menopause, for example, as a monolithic experience (which it is not) we need to address the particular patient's symptoms, needs and goals. Sometimes that involves hormone therapy; sometimes it involves reassurance and a dose of reality.
This question is such a good one, Christina, I might use it as fodder for another newsletter. So, thank you!
My husband just died on June 2. However, he had been suffering from Parkinson’s for 7 years. We have no children, so I was the only caregiver. When Dr. Lucy picked brain fog as her topic, I knew this was written just for me right now. I have reread it everyday. The Celebration of my husband’s life is scheduled on June 18. I will make it. Thanks , Dr. Lucy. Nancy Hemric
I am a retired Nurse practitioner and I absolutely agree with this entire piece about Brain Fog. The medical community has changed so much in its approach to patients and setting time limits to how long each physician can spend with any given person. You have to meet a quota in some group practices. This does not leave time to holistically look at the entire person and make a plan from there. I admire the physicians that can spend time with you and get your "story" before they jump to treatment plan. A patient needs to come into to the office with a list of their problems and questions and try to utilize the limited amount of time with the doctor to the fullest. Thank you for this post.
I would like to call your office to set up a time for a consult regarding sleep. I was on Ambien and stopped that and now take Xanax and I know there are serious problems with these drugs and dementia . I would like you to send me your office # to set up an appt. And will certainly pay you. I found you online during the pandemic and now I am a paid subscriber and enjoy your emails. All the best, Deborah Krulewitch.
Hi Deborah! Funny you should ask. I am starting to consider doing consults for patient for particular issues. I am not set up to do this yet.. especially for those outside the DC area... but stay tuned! My medical practice website is www.ackerlymcbride.com
Love love this honest view point on assessing and treating the whole person!! So many factors to consider and as you said, not a quick easy fix. Shame our healthcare doesn’t have the same viewpoints.
For some months I have been having a range of experiences in Life that are constant, or new, or changing, and they are difficult to deal with. Your analysis of another Patient's complex situation provides a road map for me to deal with many things too, and a chance to share them with my Dr. on June 19. How remarkably insightful and skillful you are in your approach to helping others. Many Thanks, and may All who are close to you be Well. John Horwood
What a wonderful article! Thank you for sharing your wisdom in a world full of BS and Health Hacks by quacks. I am lucky to have a doctor or two like you.
As Sir William Osler, a famous physician once said: “Listen to the patient. They will tell you the diagnosis.”
Wise words indeed!
Excellent advice Dr Mc Bride. The first thing to do, for sure, if someone complains of cognitive changes is to remove or ameliorate the multiple metabolic, neurologic and psychological factors that affect cognitive function, including the very real cognitive changes that often come with menopause and loss of estrogen. And yes, this requires careful listening and very nuanced management, over time. Even if correction to these factors does not yield a positive picture, then yes, one has to get into objective assessments, as you mentioned. I do want to throw in a reminder that, should there be reason to think there are cognitive changes underlying all these factors that have been addressed, then an experienced, qualified Speech Therapist or Speech Pathologist, (same person) often plays a key role in a) cognitive assessment b) helping an individual develop and use strategies to cope better or cope well, even with cognitive changes, in daily and prospective functioning. Since I have been involved with such cases, I have also had to meet with people just concerned about normal aging changes they are experiencing, to assess and address how they can help themselves and provide the necessary reassurance and education. Happy to talk with you further. I am based in Massachusetts.
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Wonderful analysis of possible causes to fatigue and brain fog. Often these symptoms are multifactorial. As a dietitian, I like your reminder about not skipping meals (and I suggest combining protein and complex carbs at each meal). One factor you didn't mention is the very high incidence of long Covid syndrome, that can contribute to brain fog and fatigue. The patient may wish to think about whether her symptoms worsened within several months of a confirmed COVID-19 infection.
Yes indeed.. cognitive impairment can be a result of myriad medical conditions.. too numerous to count. Long COVID is real and can have meaningful negative effects on cognition, but it’s not at all clear to me what the actual incidence is… given the muddy definition and other factors such as poor access to healthcare in this country which can make long COVID a convenient bucket to put medical problems that are more complicated that meets the eye… and that sometimes are indeed directly a result of COVID but that also can stem from other medical issues that are more difficult to discern without proper medical care.
Thank you for this wonderful, insightful post! Besides listening to yourself, the most important thing is finding a trusted medical guide. As your post shows, that’s getting harder and harder to do. Your patients are truly lucky to have you.
awww.. thank u
Trust is the glue in any relationship, esp patient-doctor!
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Dr. Lucy, Love your stack. What do you think about the recent article in the Lancet, proclaiming that menopause is being overmedicalized?
I think over-medicalization is a serious problem in this country - whether it's around menopause or anxiety or obesity or high cholesterol or cancer. To me, the question isn't "Are we over-medicalizing elements of the normal human experience in the U.S.?" We are!
The more salient question is, "How can we better meet the patient's needs through the combination of pharmacology, behavioral modifications, counseling, and reassurance when/if appropriate?" Instead of treating menopause, for example, as a monolithic experience (which it is not) we need to address the particular patient's symptoms, needs and goals. Sometimes that involves hormone therapy; sometimes it involves reassurance and a dose of reality.
This question is such a good one, Christina, I might use it as fodder for another newsletter. So, thank you!
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My husband just died on June 2. However, he had been suffering from Parkinson’s for 7 years. We have no children, so I was the only caregiver. When Dr. Lucy picked brain fog as her topic, I knew this was written just for me right now. I have reread it everyday. The Celebration of my husband’s life is scheduled on June 18. I will make it. Thanks , Dr. Lucy. Nancy Hemric
Dear Nancy-
I am so sorry for your loss. I am sending you love and support and hope you take good care of yourself during this difficult time.
❤️ Lucy
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I am a retired Nurse practitioner and I absolutely agree with this entire piece about Brain Fog. The medical community has changed so much in its approach to patients and setting time limits to how long each physician can spend with any given person. You have to meet a quota in some group practices. This does not leave time to holistically look at the entire person and make a plan from there. I admire the physicians that can spend time with you and get your "story" before they jump to treatment plan. A patient needs to come into to the office with a list of their problems and questions and try to utilize the limited amount of time with the doctor to the fullest. Thank you for this post.
Thank you for your note and feedback, and for reading!!
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I would like to call your office to set up a time for a consult regarding sleep. I was on Ambien and stopped that and now take Xanax and I know there are serious problems with these drugs and dementia . I would like you to send me your office # to set up an appt. And will certainly pay you. I found you online during the pandemic and now I am a paid subscriber and enjoy your emails. All the best, Deborah Krulewitch.
Hi Deborah! Funny you should ask. I am starting to consider doing consults for patient for particular issues. I am not set up to do this yet.. especially for those outside the DC area... but stay tuned! My medical practice website is www.ackerlymcbride.com
+1000 to spending time in nature!
I love every word of this post. Thank you so much for sharing this story. Yes, there's a box, damnit! :-)
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Love love this honest view point on assessing and treating the whole person!! So many factors to consider and as you said, not a quick easy fix. Shame our healthcare doesn’t have the same viewpoints.
Thank you
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This was excellent.
Thank you, Susan.
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Love reading these - thank you.
Thanks, Kate!
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For some months I have been having a range of experiences in Life that are constant, or new, or changing, and they are difficult to deal with. Your analysis of another Patient's complex situation provides a road map for me to deal with many things too, and a chance to share them with my Dr. on June 19. How remarkably insightful and skillful you are in your approach to helping others. Many Thanks, and may All who are close to you be Well. John Horwood
I am so glad... and thank you, John!
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Bless you, and thank you! Always food for thought, and action!
Appreciate the feedback, Suzette!
What a wonderful article! Thank you for sharing your wisdom in a world full of BS and Health Hacks by quacks. I am lucky to have a doctor or two like you.
So glad :)